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Tunnell NC, Corner SE, Roque AD, Kroll JL, Ritz T, Meuret AE. Biobehavioral approach to distinguishing panic symptoms from medical illness. Front Psychiatry 2024; 15:1296569. [PMID: 38779550 PMCID: PMC11109415 DOI: 10.3389/fpsyt.2024.1296569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Panic disorder is a common psychiatric diagnosis characterized by acute, distressing somatic symptoms that mimic medically-relevant symptoms. As a result, individuals with panic disorder overutilize personal and healthcare resources in an attempt to diagnose and treat physical symptoms that are often medically benign. A biobehavioral perspective on these symptoms is needed that integrates psychological and medical knowledge to avoid costly treatments and prolonged suffering. This narrative review examines six common somatic symptoms of panic attacks (non-cardiac chest pain, palpitations, dyspnea, dizziness, abdominal distress, and paresthesia), identified in the literature as the most severe, prevalent, or critical for differential diagnosis in somatic illness, including long COVID. We review somatic illnesses that are commonly comorbid or produce panic-like symptoms, their relevant risk factors, characteristics that assist in distinguishing them from panic, and treatment approaches that are typical for these conditions. Additionally, this review discusses key factors, including cultural considerations, to assist healthcare professionals in differentiating benign from medically relevant symptoms in panic sufferers.
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Affiliation(s)
- Natalie C. Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Psychiatry & Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, United States
| | - Sarah E. Corner
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Andres D. Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Primary Care Department, Miami VA Healthcare System, Miami, FL, United States
| | - Juliet L. Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | - Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
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Beyazal M, Orun UA, Sayici IU. Are children with mitral valve prolapse more anxious? Ann Pediatr Cardiol 2023; 16:331-336. [PMID: 38766459 PMCID: PMC11098292 DOI: 10.4103/apc.apc_126_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 05/22/2024] Open
Abstract
Background Mitral valve prolapse (MVP) is a common valvular disease in children. Symptoms in children with MVP are not explained by the severity of mitral regurgitation alone. Hence, we sought to correlate symptom status with the incidence of anxiety disorder in this population. Materials and Methods Groups were as follows: (a) MVP; n = 115; mean age: 13.5 ± 3.06 years and (b) control; n = 53; mean age: 15.1 ± 13.2. The Screen for Child Anxiety-Related Emotional Disorders (SCAREDs) scale was filled by all participants. The SCARED scores of 25 and above determined a warning for anxiety disorders. Results The mean SCARED scale values of MVP and control groups were 29.2 ± 13.08 and 24.9 ± 14.17, respectively (P = 0.065). Although the SCARED scale score was higher among the MVP patients, no significant difference was found between the groups in terms of the mean SCARED score, or the number of participants with a score of 25 or more. While girls with MVP had higher anxiety scores compared to boys with the disorder, there was no difference with respect to SCARED scores in children with MVP and the general population when analyzed separately by gender. Moreover, the SCARED scale score was significantly higher in symptomatic MVP patients than in asymptomatic cases. Conclusion Children with MVP did not have higher anxiety scores compared to those without the syndrome. However, MVP patients with higher anxiety scores may benefit from a psychiatric assessment since higher scores correlate with symptoms.
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Affiliation(s)
- Meryem Beyazal
- Department of Paediatric Cardiology, Dr. Sami Ulus Gynaecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Utku Arman Orun
- Department of Paediatric Cardiology, Dr. Sami Ulus Gynaecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ilker Ufuk Sayici
- Department of Paediatric Cardiology, Dr. Sami Ulus Gynaecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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The Prevalence of Mitral Valve Prolapse in Panic Disorder: A Meta-Analysis. PSYCHOSOMATICS 2019; 60:393-401. [DOI: 10.1016/j.psym.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/04/2023]
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Esfehani RJ, Kamranian H, Jalalyazdi M. Effect of Fluoxetine Administration on Clinical and Echocardiographic Findings in Patients with Mitral Valve Prolapse and Generalized Anxiety Disorder: Randomized Clinical Trial. Electron Physician 2017; 9:3483-3491. [PMID: 28243397 PMCID: PMC5308485 DOI: 10.19082/3483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 10/06/2016] [Indexed: 01/04/2023] Open
Abstract
Background Mitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP. Objective The aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety. Methods This randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015. Subjects were randomly assigned to intervention group who received propranolol and fluoxetine (both at 10 mg/day) and control group who received 10 mg/day propranolol. Assessments included echocardiography and GAD-7 questionnaire and rating of chest pain, that were performed at baseline and then weekly for 4 weeks. Analysis was performed using the Mann-Whitney U test and Two-way Repeated Measures Analysis of Variance (ANOVA). Results Sixty patients (25 male/ 35 female) with a mean age of 22.9 ± 2.5 years were studied in two groups of intervention (n = 30) and control (n = 30). GAD score was significantly higher in the intervention group (17.37 ± 1.61) compared with the control group (14.17 ± 0.83) (p<0.001). No significant difference was observed for changes in left atrium diameter, mitral annular diameter, left ventricular diameter or ejection fraction (p>0.05). Pain severity was reduced significantly more in control group (3.27 ± 1.26) compared to intervention group (2.80 ± 0.85) after treatment (p<0.001). Conclusions This study revealed that the co-administration of fluoxetine and propranolol may not only have no effective in improving echocardiographic changes of MVP but may also aggravate subjective findings of patients with MVP and GAD. Trial registration The trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2014102819721N1. Funding This research has been financially supported by Research Council of Sabzevar University of Medical Sciences.
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Affiliation(s)
- Reza Jafarzadeh Esfehani
- MD-PHD Student, Department of Medical Genetics, Mashhad University of Medical Sciences, Mashhad, Iran; Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Homan Kamranian
- MD. Psychiatrist, Assistant Professor, Department of Psychiatry, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Majid Jalalyazdi
- MD. Cardiologist, Assistant Professor, Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Bayer-Topilsky T, Suri RM, Topilsky Y, Marmor YN, Trenerry MR, Antiel RM, Mahoney DW, Schaff HV, Enriquez-Sarano M. Mitral Valve Prolapse, Psychoemotional Status, and Quality of Life: Prospective Investigation in the Current Era. Am J Med 2016; 129:1100-9. [PMID: 27235006 DOI: 10.1016/j.amjmed.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate whether mitral valve prolapse is associated with the patient's psychoemotional status and health-related quality of life. METHODS Mitral valve prolapse and mitral regurgitation were prospectively and comprehensively assessed in 281 patients (age 61 ± 13 years; 63% men); 216 patients with mitral valve prolapse were compared with 65 without mitral valve prolapse (of similar age and sex). Simultaneously, we assessed the patient's psychoemotional status (anxiety, depression, posttraumatic stress symptoms), health-related quality of life, and perceived severity of illness using validated questionnaires. RESULTS Twenty-nine percent of the patients had either no or mild mitral regurgitation (area of effective regurgitant orifice ≤0.2), and 71% had clinically significant mitral regurgitation (moderate/severe). Stratifying patients into no/mild vs moderate/severe mitral regurgitation revealed no differences in psychoemotional status or mental health-related quality of life between patients with mitral valve prolapse vs those without mitral valve prolapse within each subgroup; no/mild mitral regurgitation and moderate/severe mitral regurgitation (all P ≥ .5). In multivariate analysis, mitral valve prolapse was not independently associated with psychoemotional status or health-related quality of life (all P ≥ .4). In addition, while objective severity of the illness was not related to psychoemotional status or health-related quality of life (all P ≥ .2), the patient's perceived severity of illness predicted in and of itself all psychoemotional (all P < .03) and quality-of-life outcomes (all P < .003). CONCLUSION Mitral valve prolapse is not a determinant of the patient's psychoemotional status or quality of life. Psychoemotional status and health-related quality of life are determined by the patient's perception of the severity of the mitral valve disease, rather than by the presence of mitral valve prolapse.
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Affiliation(s)
- Tali Bayer-Topilsky
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn; The Engelberg Center for Children and Youth, JDC-Myers-Brookdale Institution, Jerusalem, Israel
| | - Rakesh M Suri
- Thoracic & Cardiovascular Surgery at Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Yan Topilsky
- Department of Cardiology, Sourasky Medical Center, Tel Aviv, Israel
| | - Yariv N Marmor
- Department of Industrial Engineering and Management, ORT Braude College of Engineering, Karmiel, Israel
| | - Max R Trenerry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn
| | - Ryan M Antiel
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Dubey NK, Syed-Abdul S, Nguyen PA, Dubey R, Iqbal U, Li YC, Chen WH, Deng WP. Association between anxiety state and mitral valve disorders: A Taiwanese population-wide observational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 132:57-61. [PMID: 27282227 DOI: 10.1016/j.cmpb.2016.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/11/2016] [Accepted: 04/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite substantial research progress in concurrent diseases, for instance comorbidities involving anxiety state (AS) and mitral valve disorders (MVD), the current measures and care are limited and no consensus about their association has yet been reached. Hence, this study aims to analyze the prevalence and association between AS and MVD among Taiwanese population. METHODS We employed phenome-wide association study (PWAS) portal to investigate the association between AS and MVD using claim data of Taiwan's National Health Insurance Research Database (NHIRD) from year 2000 to 2002. Association strength between AS and MVD was analyzed among overall age and gender groups. RESULTS We found an overall stronger association between AS and MVD, which was significantly higher in younger age group (OR 15, 95% CI 14.82-16.88) than in the elderly age group (OR 1.99, 95% CI 1.76-2.24). Also, the study reveals a higher incidence of co-occurrence in females than males, particularly in age group of 40-49. CONCLUSIONS Based on our results showing considerable strength of association between AS and MVD, this study suggests the necessity of MVD assessment in all patients with AS, particularly in younger females. Moreover, we also propose psychotherapeutic as well as pharmacologic intervention for comorbidity-based pathologies to better the quality care for high-need Taiwanese population.
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Affiliation(s)
- Navneet Kumar Dubey
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Phung Anh Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | | | - Usman Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chuan Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Wei-Hong Chen
- Stem Cell Research Center, Taipei Medical University, Taipei, Taiwan
| | - Win-Ping Deng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Stem Cell Research Center, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Basic Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
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Sanches SHB, Osório FDL, Udina M, Martín-Santos R, Crippa JAS. Anxiety and joint hypermobility association: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2013; 34 Suppl 1:S53-60. [PMID: 22729449 DOI: 10.1590/s1516-44462012000500005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anxiety disorders are often associated with several non-psychiatric medical conditions. Among the clinical conditions found in association with anxiety stands out the joint hypermobility (JH). OBJECTIVES To carry out a systematic review of the clinical association between anxiety disorders and JH. METHOD A survey was conducted in MEDLINE, PsychINFO, LILACS e SciELO databases up to December 2011. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety. The reference lists of selected articles were systematically hand-searched for other publications relevant to the review. RESULTS Seventeen articles were included in the analysis and classified to better extract data. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Panic disorder/agoraphobia was the anxiety disorder associated with JH in several studies. Etiological explanation of the relationship between anxiety and JH is still controversial. CONCLUSION Future research in large samples from the community and clinical setting and longitudinal studies of the association between anxiety and HA and the underlying biological mechanisms involved in this association are welcome.
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Affiliation(s)
- Simone H Bianchi Sanches
- Neurosciences and Behavior Department, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil.
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Bianchi Sanches SH, Osório FDL, Udina M, Martín-Santos R, Crippa JAS. Anxiety and joint hypermobility association: a systematic review. BRAZILIAN JOURNAL OF PSYCHIATRY 2012. [DOI: 10.1016/s1516-4446(12)70054-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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